Question 1
1 out of 1 points
Which dietary adjustments does the nurse recommend to an older
adult client asking what changes she should institute to prevent or
manage constipation?
Correct C.
Answer:
“Include plenty of
fiber.”
Response Older adults are prone to constipation. To manage or
Feedback
:
prevent constipation, teach the older client to drink
eight glasses of water daily and to take in plenty of fiber.
These guidelines are good for other clients as well. The
other suggestions will not prevent or help manage
constipation.Cognitive Level: ComprehensionNCLEX
Blueprint: Health Promotion and Maintenance (Self-Care)
Question 2
0 out of 1 points
The strategy to avoid medication errors endorsed by the Institute
for Safe Medication Practices (ISMP) to differentiate products with
look-alike names is referred to as
Correct D.
Answer:
tallman
lettering.
Response Tallman lettering is a term coined by ISMP to describe
Feedback
:
the practice of using unique letter characteristics of
similar drug names known to have been confused with
one another. Tallman lettering is used to differentiate
, products with look-alike names such as BenaDRYL
(antihistamine) and BenaZEPRIL (ace inhibitor). The
other options are examples of safety-enhancing
technologies strategies designed to minimize drug
errors, but they are not directed at look-alike
medications. Automatic alerts are computer-generated
alarms that can be programmed to occur with such
things as allergies and incompatible medications. Bar
coding is used with medication administration systems
that can be programmed to match patient identification
bracelets with documentation. Computer order entry
systems are designed to include components of a
standard medication order.Cognitive level:
applicationNCLEX Blueprint: Pharmacology and Parental
therapies
Question 3
1 out of 1 points
A home care nurse receives a physician order for a medication that
the patient does not want to take because the patient has a history
of side effects from this medication. The nurse carefully listens to
the patient, considers it in light of the patient's condition, questions
its appropriateness, and examines alternative treatments. This
nurse would most likely
Correct A.
Answer:
call the physician, explain rationale, and suggest a
different medication.
Response Determining how best to proceed on behalf of a
Feedback
:
patient's best health care outcomes may require clinical
judgment. At the committed level of critical thinking, the
nurse chooses an action after all possibilities have been
examined. A home care nurse who is using good clinical
judgment techniques should have confidence in their
decision and may not have another nurse available as
this is an autonomous setting. Holding the drug might
jeopardize the patient's health, so this is not the best
, solution. The nurse working at this level of critical
thinking makes choices based on careful examination of
situations and alternatives; whether or not the physician
is open to nursing input is not relevant.Cognitive level:
applicationNCLEX Blueprint: Management of care
Question 4
0 out of 1 points
A nurse is caring for a client with stress incontinence. The nurse
knows that which effect could have led to such a condition?
Correct D.
Answer:
Loss of muscle
tone
Response The nurse should know that the loss of muscle tone
Feedback
:
leads to stress incontinence in the elderly. The bladder
muscles become weak, which also leads to urinary
retention and dribbling as stress incontinence. Reduced
bladder capacity, decreased urine formation, and
reduced renal blood flow are common problems
associated with the urinary system as a result of
advanced age, but they do not specifically lead to stress
incontinence.Cognitive Level: ApplicationNCLEX
Blueprint: Management of Care
Question 5
1 out of 1 points
A client will be undergoing palliative surgery. The client’s daughter
asks what this means. What is the nurse’s best response?
Correct A.
Answer:
, “The surgery will relieve the symptoms but will not
cure your father.”
Response The purpose of palliative surgery is to improve the
Feedback:
client’s quality of life by reducing or eliminating
distressing symptoms. It does not cure a health problem
and often does not prolong life.Cognitive level:
comprehensionNCLEX Blueprint: Basic care and comfort
Question 6
1 out of 1 points
The nursery nurse identifies a newborn at significant risk for
hypothermic alteration in thermoregulation because the patient is
Correct B.
Answer:
low birth
weight.
Response Low birth weight and poorly nourished infants
Feedback
:
(particularly premature infants) and children are at
greatest risk for hypothermia. A large for gestational
age infant would not be malnourished. An infant born at
term is not considered at significant risk. A well-
nourished infant is not at significant risk.Cognitive Level:
applicationNCLEX Blueprint: Physiological Adaptation
Question 7
1 out of 1 points
The priority nursing intervention for a patient suspected to be
hypothermic would be to
Correct D.
Answer:
1 out of 1 points
Which dietary adjustments does the nurse recommend to an older
adult client asking what changes she should institute to prevent or
manage constipation?
Correct C.
Answer:
“Include plenty of
fiber.”
Response Older adults are prone to constipation. To manage or
Feedback
:
prevent constipation, teach the older client to drink
eight glasses of water daily and to take in plenty of fiber.
These guidelines are good for other clients as well. The
other suggestions will not prevent or help manage
constipation.Cognitive Level: ComprehensionNCLEX
Blueprint: Health Promotion and Maintenance (Self-Care)
Question 2
0 out of 1 points
The strategy to avoid medication errors endorsed by the Institute
for Safe Medication Practices (ISMP) to differentiate products with
look-alike names is referred to as
Correct D.
Answer:
tallman
lettering.
Response Tallman lettering is a term coined by ISMP to describe
Feedback
:
the practice of using unique letter characteristics of
similar drug names known to have been confused with
one another. Tallman lettering is used to differentiate
, products with look-alike names such as BenaDRYL
(antihistamine) and BenaZEPRIL (ace inhibitor). The
other options are examples of safety-enhancing
technologies strategies designed to minimize drug
errors, but they are not directed at look-alike
medications. Automatic alerts are computer-generated
alarms that can be programmed to occur with such
things as allergies and incompatible medications. Bar
coding is used with medication administration systems
that can be programmed to match patient identification
bracelets with documentation. Computer order entry
systems are designed to include components of a
standard medication order.Cognitive level:
applicationNCLEX Blueprint: Pharmacology and Parental
therapies
Question 3
1 out of 1 points
A home care nurse receives a physician order for a medication that
the patient does not want to take because the patient has a history
of side effects from this medication. The nurse carefully listens to
the patient, considers it in light of the patient's condition, questions
its appropriateness, and examines alternative treatments. This
nurse would most likely
Correct A.
Answer:
call the physician, explain rationale, and suggest a
different medication.
Response Determining how best to proceed on behalf of a
Feedback
:
patient's best health care outcomes may require clinical
judgment. At the committed level of critical thinking, the
nurse chooses an action after all possibilities have been
examined. A home care nurse who is using good clinical
judgment techniques should have confidence in their
decision and may not have another nurse available as
this is an autonomous setting. Holding the drug might
jeopardize the patient's health, so this is not the best
, solution. The nurse working at this level of critical
thinking makes choices based on careful examination of
situations and alternatives; whether or not the physician
is open to nursing input is not relevant.Cognitive level:
applicationNCLEX Blueprint: Management of care
Question 4
0 out of 1 points
A nurse is caring for a client with stress incontinence. The nurse
knows that which effect could have led to such a condition?
Correct D.
Answer:
Loss of muscle
tone
Response The nurse should know that the loss of muscle tone
Feedback
:
leads to stress incontinence in the elderly. The bladder
muscles become weak, which also leads to urinary
retention and dribbling as stress incontinence. Reduced
bladder capacity, decreased urine formation, and
reduced renal blood flow are common problems
associated with the urinary system as a result of
advanced age, but they do not specifically lead to stress
incontinence.Cognitive Level: ApplicationNCLEX
Blueprint: Management of Care
Question 5
1 out of 1 points
A client will be undergoing palliative surgery. The client’s daughter
asks what this means. What is the nurse’s best response?
Correct A.
Answer:
, “The surgery will relieve the symptoms but will not
cure your father.”
Response The purpose of palliative surgery is to improve the
Feedback:
client’s quality of life by reducing or eliminating
distressing symptoms. It does not cure a health problem
and often does not prolong life.Cognitive level:
comprehensionNCLEX Blueprint: Basic care and comfort
Question 6
1 out of 1 points
The nursery nurse identifies a newborn at significant risk for
hypothermic alteration in thermoregulation because the patient is
Correct B.
Answer:
low birth
weight.
Response Low birth weight and poorly nourished infants
Feedback
:
(particularly premature infants) and children are at
greatest risk for hypothermia. A large for gestational
age infant would not be malnourished. An infant born at
term is not considered at significant risk. A well-
nourished infant is not at significant risk.Cognitive Level:
applicationNCLEX Blueprint: Physiological Adaptation
Question 7
1 out of 1 points
The priority nursing intervention for a patient suspected to be
hypothermic would be to
Correct D.
Answer:
